The latest edition of Dermatology News contains an opinion piece, written by Dr. Brett Coldiron, in which he has laid out some wishes for the new Trump administration. As you read the article, “Unshackle American Medicine,” it is hard to argue with many of his comments especially, as he points out, how many “regulations are regulatory overkill” that have the effect of decreasing efficiency and increasing overhead. However, he does comment on one particular issue that is contradictory to his desire to eliminate unnecessary barriers to patient care. Dr. Coldiron is advocating for repeal of the ability of Physician Assistants (PA) and Nurse Practitioners (NP) to bill independently for surgical procedures. By definition, many of the procedures performed on a daily basis by well-trained PAs in dermatology (biopsies, cryotherapy, and excisions) would be included in his proposition. Eliminating the ability for PAs and NPs to perform these procedures would decrease access to care and delay the time to treatment or diagnosis. In addition, this limitation would impose unnecessary burden upon dermatologists who would then have to perform these simple procedures when they could focus on more complex cases. Dr. Coldiron claims that direct billing subjects patients to unnecessary procedures by inadequately trained providers and generates unnecessary costs. These are unsubstantiated claims that are unfortunately allowed in his opinion piece with no need for referencing data. In the past his opinions were not supported by his own academy. One example is “Scope of Physician Procedures Independently Billed by Mid-Level Providers in the Office Setting” published in JAMA Dermatology August 11, 2014. When this article was published it included a statement that the article did not represent the opinion of the American Academy of Dermatology, of which he was the President at the time.
The SDPA supports PAs practicing in a manner appropriate with their level of education, training, and experience in collaboration with board certified dermatologists. It is those same dermatologists who are in the best position to determine when a PA has had adequate training to proceed with procedures and bill accordingly. Any legislation restricting our ability to perform procedures undermines the ability of dermatologists to make their own decisions regarding PA/NP practice in their office. We encourage SDPA members to contact Dermatology News (email the Editor-In-Chief, Mary Jo M. Dales), to provide your input on Dr. Coldiron’s ongoing derogatory attacks against our profession. Please also ask your collaborating physicians to provide their insight based on actual experience with the value PAs bring to their practice.